Senior Fraud, Waste and Abuse (FWA) Specialist

$65.3k - $111k

Full-time

PacificSource

Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
The Senior Fraud, Waste and Abuse (FWA) Specialist serves as the organization's subject matter expert responsible for supporting and advancing PacificSource's Payment Integrity and FWA programs. This role provides operational expertise in program development, compliance oversight, fraud prevention, payment integrity initiatives, regulatory reporting and audit management. This position leads program administration activities, partners with operational teams and regulatory agencies, and develops processes that strengthen the organization's ability to detect, prevent, investigate, recover, and report fraud, waste, abuse, and payment integrity concerns.
Essential Responsibilities:
Support the development and maintenance of the Payment Integrity and FWA program framework.
Develop, implement, and maintain program policies, workflows, procedures, and controls.
Maintain centralized tracking and reporting systems for investigations, recoveries, referrals, and regulatory activities.
Coordinate annual audit, monitoring, and work plan activities.
Serve as primary liaison with CMS, MEDIC, OHA, Medicaid Fraud Units, and other oversight agencies.
Ensure timely and accurate submission of FWA and payment integrity reporting requirements.
Monitor regulatory requirements and recommend program enhancements.
Support internal and external audits and corrective action initiatives.
Analyze program performance, recovery results, and fraud prevention outcomes.
Identify fraud schemes, payment vulnerabilities, and emerging risks.
Collaborate with analytics teams to develop prospective and retrospective monitoring strategies.
Develop recommendations to improve program effectiveness and financial recoveries.
Develop and deliver FWA training and awareness programs.
Chair or coordinate Program Integrity Committee activities.
Prepare reports and presentations for leadership, compliance committees, and the Board.
Serve as an internal subject matter expert on FWA and Payment Integrity matters.
Supporting Responsibilities:
Participate in compliance initiatives as needed.
Perform day-to-day tasks of the compliance department as needed.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of 5 years of experience in fraud, waste, and abuse (FWA), payment integrity, healthcare compliance, claims auditing, claims analysis, or related healthcare operations functions. Experience analyzing healthcare claims data, identifying potential payment integrity risks, and supporting FWA monitoring, reporting, or compliance activities required. Experience working with Medicare and/or Medicaid programs preferred. Experience with data mining, analytics, regulatory reporting, or collaboration with investigative teams is highly desirable.
Education, Certificates, Licenses: Bachelor's degree in business, management, health care administration or related field required. Candidates with an associate's degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered.
Knowledge: Ability to gain a thorough understanding of PacificSource compliance initiatives. Ability to organize large projects that involve working with multi-functional teams under strict deadlines. Working knowledge of fraud, waste, and abuse (FWA) concepts, payment integrity practices, healthcare claims processing, and Medicare and Medicaid requirements. Ability to analyze claims data, identify trends and potential risks, and prepare reports and recommendations. Strong analytical and organizational skills. Working knowledge of medical terminology and healthcare reimbursement processes. Ability to collaborate effectively with internal stakeholders and maintain confidentiality when handling sensitive information. Ability to communicate effectively with all levels of the organization both verbally and in writing. Working knowledge of medical terminology. Ability to work under pressure, deadlines, and to deal with emotional situations.
Competencies
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Compensation Disclaimer
The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.
Base Range:
$65,296.83 - $111,004.62
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Apply

Vacancy posted 21 hours ago

Similar jobs that could be interesting for youBased on the Senior Fraud, Waste and Abuse (FWA) Specialist in Bend, OR vacancy

Senior Fraud, Waste and Abuse (FWA) Investigator
$65.3k - $111k
...develop and utilize each person's talents and strengths. The Senior Fraud, Waste and Abuse Investigator manages work related to fraud, waste and abuse... ...and liabilities. Attend and participate in regional FWA Task Force and other state or federal meetings....
Senior
Fraud
Full time
Contract work
Work experience placement
Work at office
PacificSource
Bend, OR
21 hours ago
Mental Health Group Specialist
...in high-impact group facilitation. As a Mental Health Group Specialist, you will begin making a difference on day one, working alongside... ...job posting. Please be cautious of potential recruitment fraud. If you are interested in exploring opportunities at Charlie Health...
Fraud
Full time
Local area
Remote work
Charlie Health
Bend, OR
14 days ago
Specimen Collector
$18 - $21 per hour
...* National, federal, and county criminal history * Global watchlist search * Social Security Number (SSN) trace * FACIS (Fraud and Abuse Control Information System) Level 3 search * SAM (System for Award Management) and OIG (Office of Inspector General) exclusions...
Fraud
Part time
Work at office
1 day per week
Millennium Health
Bend, OR
2 days ago
Delivery Specialist - Hub-1
Delivery Driver Deliver parts and/or products to O'Reilly stores and DC in a safe and efficient manner. Bilingual candidates encouraged to apply. Essential Job Functions Drive company vehicle to deliver parts and products to stores and/or distribution center...
Suggested
Local area
Immediate start
Flexible hours
O'Reilly Auto Parts
Bend, OR
5 days ago
Photo Specialist
...members on photo department operations and services to ensure adequate coverage and operational continuity during times when the Photo Specialist is not scheduled. Follows company policies, asset protection standards, and applicable regulatory requirements to help ensure...
Suggested
Work experience placement
Seasonal work
Flexible hours
Afternoon shift
Walgreens Boots Alliance
Bend, OR
3 days ago
Delivery Specialist
...Delivery Specialist The Delivery Specialist will maintain and operate store vehicles to deliver parts and/or products to professional customers in a safe and efficient manner. This position will also collect money on C.O.D. deliveries and pick up customer returns....
Local area
Immediate start
Remote work
Flexible hours
O'Reilly Auto Parts
Bend, OR
1 day ago
Seasonal Facilities Specialist 1- Ice Maintenance
...please click here About the job: The Seasonal Facilities Specialist 1 is responsible for performing semi-skilled facility... ...needed. Acts as a Mandatory Reporter; reports incidents of child abuse/neglect. Perform other duties as assigned. Schedule and...
Full time
Temporary work
Seasonal work
Night shift
Bend Metro and Park Recreation District
Bend, OR
9 days ago
Housekeeping Specialist
$22 per hour
Job Description Job Description Do you notice things other people miss? Are you the type to take pride in cleaning a room so well that you would happily put your own family in it for the night? If you’ve ever remade a bed because the hospital corners were personally...
Hourly pay
Full time
Flexible hours
Night shift
Weekend work
Day shift
Multiporpoise Management
Bend, OR
7 days ago
APPAREL/CLERK
...management of customer or employee accidents. Report all safety risks, or issues, and illegal activity, including: robbery, theft or fraud. Must be able to perform the essential functions of this position with or without reasonable accommodation. Qualifications...
Fraud
Seasonal work
Local area
Shift work
Kroger Family of Companies
Bend, OR
1 day ago
Senior Environmental Engineer
...Senior Environmental EngineerSerán Bioscience, LLC is a solid dosage pharmaceutical contract development and manufacturing organization... ...continuous improvement efforts related to air quality, water resources, waste management, pollution prevention, and sustainability performance...
Senior
Contract work
For contractors
Work at office
Local area
Serán BioScience
Bend, OR
5 days ago
RN - Senior Living
$105k - $110k
Job TitleLocation 20215 Powers Road, Bend, OR, 97702, United StatesBase Pay $105,000.00 - $110,000.00 / YearJob Category Health Services, Director, ManagementEmployee Type FT ExemptManage Others YesMinimum Experience 2 YearsDescription Requirements SummaryDescription Requirements...
Senior
Brightwater Senior Living - Arbol of Santa Rosa Healthcare
Bend, OR
1 day ago
RN - Senior Living
$105k - $110k
Job Title Location 20215 Powers Road, Bend, OR, 97702, United States Base Pay $105,000.00 - $110,000.00 / Year Job Category Health Services, Director, Management Employee Type FT Exempt Manage Others Yes Minimum Experience 2 Years Description Requirements...
Senior
Brightwater Senior Living - Arbol of Santa Rosa Healthcare
Bend, OR
2 days ago
Bulk Foods Clerk
...success. We are committed cultivating and celebrating an inclusive environment in which all employees are valued and respected. Fraud alert: WinCo advises job seekers to be cautious of unsolicited job offers and to verify the authenticity of any communication claiming...
Fraud
Shift work
Night shift
WinCo Foods
Bend, OR
1 day ago
HOME PHOTO ELEC/CLERK
...management of customer or employee accidents. Report all safety risks, or issues, and illegal activity, including: robbery, theft or fraud. Must be able to perform the essential functions of this position with or without reasonable accommodation. Qualifications...
Fraud
Hourly pay
Part time
Seasonal work
Local area
Shift work
Kroger
Bend, OR
1 day ago
Tax Senior
$80k - $100k
Tax Senior | Hybrid | $80,000 - $100,000Position OverviewWe are seeking an experienced Tax Senior to lead client engagements and provide high-quality tax compliance and planning services. In this hybrid role, you will be responsible for preparing and reviewing federal...
Senior
CyberCoders
Bend, OR
11 hours ago
Specimen Collector - 1702
$18 - $21 per hour
...• National, federal, and county criminal history • Global watchlist search • Social Security Number (SSN) trace • FACIS (Fraud and Abuse Control Information System) Level 3 search • SAM (System for Award Management) and OIG (Office of Inspector General) exclusions...
Fraud
Part time
Work at office
1 day per week
Millennium Health
Bend, OR
8 days ago
RN - Senior Living
Description Mt. Bachelor Assisted Living and Memory Care, a Brightwater community, is seeking a Health Services Director for the o verall management of the Health Services Department for the Community. Overall management of the Health Services Department for the Community...
Senior
Relief
Shift work
Brightwater Senior Living
Bend, OR
1 day ago
Senior R&D Scientist - Novel Biologics Delivery
Senior R&D Scientist - Novel Biologics Delivery Bend, ORThe actual location of this job is in Bend, Oregon (USA). Relocation assistance is available for eligible candidates and their families, if needed.This is a fully site‑based role. Working together in person supports...
Senior
Full time
Local area
Relocation package
Lonza
Bend, OR
1 day ago
Part-Time Shipping & Receiving Associate
$21.5 per week
IMMEDIATE OPENINGS! Come for a job and stay for a career! Federal Express Corporation (FEC) is part of the rapidly growing warehouse and transportation sector that helps keep America, and our economy, moving. Be part of a winning team and workplace community that cares...
Weekly pay
Full time
Part time
Immediate start
Flexible hours
Shift work
FedEx
Bend, OR
11 hours ago
HSE Specialist/WSER III
...HSE Specialist/WSER III JOB-10047263 Anticipated Start Date August 17, 2026 Location Washington, DC Type of Employment Contract Hire Employer Info Our client is a worldwide hydrocarbon production and exploration company based in...
Full time
Contract work
Local area
Worldwide
Dynamics ATS
Bend, OR
a month ago
Quality Assurance Senior Specialist
...Quality Assurance Senior SpecialistSerán is seeking a Quality Assurance Senior Specialist who will be responsible for performing the day-to-day tasks of the QA Department supporting a GMP facility manufacturing, storing, and testing pharmaceutical products. Primary responsibilities...
Senior
Serán BioScience
Bend, OR
4 days ago
Senior Vice President, Chief Financial Officer
...Health System, headquartered in Bend, Oregon, is seeking a strategic, collaborative, and accomplished financial executive to serve as Senior Vice President, Chief Financial Officer. Reporting directly to the President and Chief Executive Officer, this is an exceptional...
Senior
St Charles Health System
Bend, OR
3 days ago
SSVF Housing Specialist 4 day work week
Job Description Job Description Summary/Objective This position is responsible for increasing access to both private and public rental markets for Veterans moving from homelessness to permanent housing. This position includes both community outreach, focused on...
Permanent employment
Internship
Work at office
Central Oregon Veterans Outreach
Bend, OR
13 days ago
InStore Event Specialists
$18 per hour
Job Description Job Description Pay Rate: $18 per hour Job description: Looking for Flexible, Part-Time Work? We’d Love Your Experience! Join Premier Connections as a Weekend Food Demonstrator! Are you energetic, outgoing, and enjoy chatting with people?...
Hourly pay
Extra income
Part time
Local area
Flexible hours
Shift work
Weekend work
Premier Connections LLC
Bend, OR
9 days ago
Eating Disorder Specialist
$70.89k - $103.38k
Job Description Job Description Job Summary: Vista Counseling is seeking a highly skilled and compassionate therapist to join our team. We are a dynamic and growing practice that provides comprehensive mental health services to individuals and families in need. ...
Full time
Private practice
Work at office
Vista Counseling & Wellness Center
Bend, OR
9 days ago
Warranty/RMA Specialist
$24 - $30 per hour
...opportunities in aerospace manufacturing, we'd love to meet you. WHAT YOU'LL DO As a member of the Purchasing Team, the Warranty/RMA Specialist is responsible for managing the return of non-conforming materials to suppliers and maintaining accurate, organized records...
Work at office
Relocation package
Monday to Friday
Epic Aircraft
Bend, OR
21 days ago
Office Specialist
$20 per hour
Job Description Job Description Bend Riverside Rentals LLC is a growing rental company. We manage roughly 65 condos, studios, and cottages at the former Bend Riverside Inn and Suites, which went out of business in March 2020. We also manage units at the adjacent Pioneer...
Hourly pay
Full time
Work at office
Night shift
Multiporpoise Management
Bend, OR
8 days ago
Senior Tax Manager
About Us We are a fast-growing CPA firm with 16 offices across the western U.S. providing tax planning and advisory services supported by audit, bookkeeping, and payroll services. Through strong partnerships with financial advisors and attorneys, we deliver a fully ...
Senior
Work at office
Immediate start
Relocation package
Flexible hours
Capstone Corporation
Bend, OR
4 days ago
Senior Traffic Engineer
...strategic communications, economists, management consultants and specialists across disciplines to solve complex mobility challenges with... ...that connects employees around the world.In the role of Senior Traffic Engineer, we'll count on you to: Perform complex traffic...
Senior
Contract work
Temporary work
Work at office
HDR
Bend, OR
4 days ago
Online Order Filling Team Associate
Walmart Stores | Medical, Dental, Vision, Rx + 401(k) with match + PTO + 100% Reimbursement of Tuition & Books | 20120 Pinebrook Boulevard | Responsibilities: Fill and dispense online orders with accuracy; Locate, prepare, and package merchandise for online orders; Make...
Immediate start
Wal-Mart Stores , Inc.
Bend, OR
5 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Senior Fraud, Waste and Abuse (FWA) Specialist. Be the first to apply!